Abstract
Introduction Medical education is shifting toward experiential, competency-based approaches that emphasize clinical reasoning and practical skills. Simulation-based learning (SBL) supports this shift by offering a safe, structured setting where students enhance cognitive and psychomotor abilities through active practice, timely feedback, and reflection. This fosters deeper engagement with clinical content and builds confidence before patient encounters. Global research indicates that SBL enhances various competencies, but Indian studies are limited. Factors like insufficient early clinical exposure and high student-to-patient ratios necessitate local research. This study assesses the effects of simulation-based medical education (SBME) on clinical competencies in Indian undergraduates and investigates learner perceptions and performance influencers. Methodology An interventional study was performed in 2023-2024 with 56 undergraduate medical students in Phases II and III. Simulation training occurred in two phases, spaced six months apart, utilizing low- and medium-fidelity mannequins alongside validated checklists. Phase I measured performance in basic life support (BLS), advanced trauma life support (ATLS), and anterior nasal packing before and after simulation. Phase II assessed skill retention via simulations of nasogastric tube insertion and urinary catheterization, emphasizing pre-procedural steps and communication. Results Simulation-based training yielded significant enhancements across all five clinical procedures. In BLS, all 17 tasks demonstrated improvement (χ²=4.083-21.043, p<0.05), reflecting increased emergency response proficiency with moderate to large effect sizes (Cramer's V=0.30-0.55). Anterior nasal packing showed progress in 11 of 13 tasks, particularly in communication and pain management, although insertion steps exhibited minimal change due to high baseline proficiency. ATLS training resulted in enhancements in 22 of 25 tasks (χ²=4.000-17.053, p<0.05; Cramer's V=0.28-0.50), especially in airway management and documentation. Non-significant alterations in three tasks indicate potential areas for curricular enhancement. Nasogastric tube insertion demonstrated improvements in 15 of 17 tasks, particularly in procedural sequence, with moderate effect sizes (Cramer's V=0.32-0.46). In Foley catheterization, 13 of 15 tasks improved, particularly in recognizing clinical indications (χ²=4.167, p=0.041; Cramer's V=0.31). Confidence intervals for effect sizes ranged from 95% CI [0.20-0.60], reflecting a consistent educational impact. Overall, simulation training significantly enhanced clinical skills, particularly in areas with moderate baseline proficiency. Conclusion Simulation-based learning significantly improved both immediate clinical performance and long-term skill retention, particularly in procedures with moderate baseline proficiency. Regular, structured simulations enhanced technical accuracy and patient-centered competencies within the competency based medical education (CBME) framework. While the single-center design and small sample size (n=56) limit generalizability, this reflects the institutional batch size. Despite this, the use of validated checklists ensures reliable outcomes, supporting the integration of simulation into routine medical training.